Objectives.The aim was to evaluate the cost-effectiveness of sentinel lymph node (SLN) mapping in comparison to routine pelvic lymphadenectomy for lymph node assessment in patients with high-risk endometrial cancer (EC).Methods.A decision–analytic model was developed to compare SLN mapping with pelvic lymphadenectomy for guiding adjuvant therapy in patients with high-risk endometrioid and non-endometrioid EC, focusing on costs and health outcomes. The input data were obtained from systematic literature searches and expert consensus. Quality-adjusted life years (QALYs) was utilized as the measure of effectiveness. The model was constructed from a healthcare perspective, and the impact of uncertainty was evaluated through sensitivity analyses.Results.The base case analysis indicated that sentinel lymph node mapping is the dominant strategy for lymph node assessment in patients with high-risk endometrial cancer, as it was found to be both more effective and less costly than lymphadenectomy. The improved outcomes and reduced costs associated with SLN mapping primarily result from a decrease in the side effects related to lymph node assessment. Sensitivity analyses demonstrated that the outcome of the model was robust to variations in input values.Conclusion.SLN mapping is the most cost-effective strategy to determine the need for adjuvant therapy in patients with high-risk endometrioid and non-endometrioid endometrial cancer.
目的。本研究旨在评估前哨淋巴结（SLN）绘图与常规盆腔淋巴结清扫术在高危子宫内膜癌（EC）患者淋巴结评估中的成本效益。方法。构建决策分析模型，比较SLN绘图与盆腔淋巴结清扫术在指导高危子宫内膜样和非子宫内膜样子宫内膜癌患者辅助治疗方面的成本与健康结局。输入数据来源于系统性文献检索和专家共识。采用质量调整生命年（QALYs）作为效果衡量指标。模型基于医疗体系视角构建，并通过敏感性分析评估参数不确定性的影响。结果。基础案例分析表明，前哨淋巴结绘图是高危子宫内膜癌患者淋巴结评估的优势策略，其效果优于淋巴结清扫术且成本更低。SLN绘图带来的结局改善和成本降低主要源于淋巴结评估相关副作用的减少。敏感性分析显示模型结果对输入参数的变化具有稳健性。结论。对于高危子宫内膜样和非子宫内膜样子宫内膜癌患者，前哨淋巴结绘图是确定辅助治疗需求最具成本效益的策略。
The Cost-Effectiveness of Sentinel Lymph Node Mapping in High-Risk Endometrial Cancer
肿瘤(癌症)患者之家